The primary cause of foetal illness is placental pathology. The use of diagnostic ultrasound allows for a better understanding of how the foetus may be compromised by inadequate placental function.
Anaesthesia affects placental function by changing uteroplacental and umbilical placental perfusion. Regional anaesthesia may have a beneficial effect on these circulations although general anaesthesia may be adapted to produce minimal disturbance of placental circulatory dynamics.
The advantages and disadvantages of particular anaesthetic techniques in the delivery of the sick foetus are discussed.
JouppilaP., KuikkaJ., JouppilaR., HolmenA.Effect of induction of general anaesthesia for caesarean section on intervillous blood flow. Acta Obstet Gynaecol Scand1979; 58: 249–253.
7.
RekonenA., LuotolaH., PitkanenM., KuikkaJ., PyoralaT.Measurement of intervillous and myometrial blood flow by intravenous Xe133 method. Br J Obstet Gynaecol1976; 83: 723–728.
8.
CosmiE.V., ShniderS.M.Obstetric anaesthesia and uterine blood flow. In: Obstetric Anaesthesia, 2nd Ed. ShniderS.M., LevinsonG. eds Williams and Wilkins, 1987; ch 3.
9.
MarxG.F., ShashikantP., BermanJ., FarmakidesG., SchulmanH.Umbilical blood flow velocity waveforms in different maternal positions and epidural analgesia. Obstet Gynecol1986; 68: 61–64.
10.
GilesW.B., LahF.X., TrudingerB.J.The effect of epidural anaesthesia for caesarean section on maternal uterine and fetal umbilical artery blood flow velocity waveforms. Br J Obstet Gynaecol1987; 94: 55–59.
11.
JouppilaR., JouppilaP., KuikkaJ., HollmenA.Effect of segmental extradural analgesia on placental blood flow during normal labour. Br J Anaesth1978; 50: 563–567.
12.
VeilleJ.C., YoungstromP., KanaanC., WilsonB.Human umbilical artery flow velocity waveforms before and after regional anaesthesia for caesarean section. Obstet Gynecol1988; 72: 890–893.
13.
JouppilaP., JouppilaR., HollmenA., KoivulaA.Lumbar epidural analgesia to improve intervillous blood flow during labour in severe pre-eclampsia. Obstet Gynecol1982; 59: 158–161.
14.
GroverR.F.The fascination of the hypoxic lung. Anesthesiology1985; 63: 580–582.
15.
MarshallB.E., MarshallC.A model for hypoxic constriction of the pulmonary circulation. J Appl, Physiol1988; 64, 1: 68–77.
16.
HodgkinsonR., HusainF.J., HayashiR.H.Systemic and pulmonary blood pressure during caesarean section in parturients with gestational hypertension. Can Anaesth Soc J1980; 27: 389–394.
17.
PengA.T., GormanR.S., ShulmanS.M., DemarchisE., NyuntK., BlancatoL.Intravenous nitroglycerin for uterine relaxation in the postpartum patient with retained placenta. Anesthesiology1989; 71: 172–173.